Change Order Request Form

Use this form to request changes for a Purchase Order. These changes may include canceling lines, increasing amounts, and changing indexes (See Section 2 below). All sections must be filled out completely. After Purchasing has reviewed your request, an e-mail will be sent to the address indicated with information regarding this request. If you have any questions, please contact Purchasing at 8301.

Section 1

UV ID:
Name:
Extension:
E-mail:
Purchase Order Number:
Vendor:

Section 2

Please select a change type from the list below.






Section 3

Cancel PO line item

Indicate the lines that need to be canceled

Line Item Number:
Line Item Description:
 
Line Item Number:
Line Item Description:
 
Line Item Number:
Line Item Description:
 
Line Item Number:
Line Item Description:
 
Line Item Number:
Line Item Description:
 
Change line item

Indicate the lines that need to be changed. Please fill out the entire row for each item that needs to be changed.

Line #:
Current Description:
Current Qty:
Current Unit Price:
New Description:
New Qty:
New Unit Price:
 
Line #:
Current Description:
Current Qty:
Current Unit Price:
New Description:
New Qty:
New Unit Price:
 
Line #:
Current Description:
Current Qty:
Current Unit Price:
New Description:
New Qty:
New Unit Price:
 
Line #:
Current Description:
Current Qty:
Current Unit Price:
New Description:
New Qty:
New Unit Price:
 
Line #:
Current Description:
Current Qty:
Current Unit Price:
New Description:
New Qty:
New Unit Price:
 
Change amount on Standing PO

Indicate the requested change to the amount on the Standing Purchase Order.

 
 
Change Index on PO

Indicate the changes that need to be made to the account information on the Purchase Order. The Purchase Order will be changed to the Index(es) listed in the New Index(es) section.

Current Index(es)

Index:
Amount:
 
Index:
Amount:
 
Index:
Amount:
 

New Index(es)

Index:
Amount:
 
Index:
Amount:
 
Index:
Amount:

 

Section 4

Provide an explanation for this change. If requesting a cancelation, provide verification that the order has been canceled with the vendor. You can also include additional information Purchasing will need to complete this change order.